Causes of Mediastinitis and Its Surgical Treatment

Mediastinitis remains a potentially fatal complication of cardiac surgery. This study reviews the risk factors for mediastinitis after cardiac surgery, and discusses current treatment and prevention of this complication. This review explores three major independent risk factors for mediastinitis including individual patient factors, surgical procedures and microbiology. The perioperative period is influenced by the utilization of the internal mammary artery in conjunction with coronary artery bypass grafting, sternal fixation, vacuum-assisted closure, and negative pressure wound therapy. Staphylococcus aureus and Staphylococcus epidermidis are frequently encountered microorganisms. Additionally, aerobic gram-negative microorganisms and other infrequent microorganisms are also exhibiting a rising trend. Since sternal fixation devices effectively enhance sternal stability, alleviate wound pain, and decrease the occurrence of postoperative mediastinitis, they have been specifically incorporated into certain therapeutic and prophylactic approaches for addressing this complication. Despite the heightened awareness regarding mediastinitis, the large proportion of individuals at risk underscores the crucial need for rigorous monitoring of potential risk factors, posing a significant challenge to the implementation of effective therapeutic and preventative strategies.